1. IV Catheterization VTHT 1491- Special Topics Ms. Liddell CTVT: Chapter 20 (pg: 607-610) VTDRG: Chapter 8 (pg: 349-351)

2. Learning Objectives  Describe the procedure for placement and care of a peripheral intravenous catheter  Describe the indications and procedure for placement and care of a jugular catheter  List requirements for monitoring of patients with intravenous catheters

3. 3 IV Catheterization Used for: Temporary access for medications, fluid and electrolyte replacement therapy, or transfusion of blood products

4. IV Catheterization  Catheter site selection depends on:  Available vessels  Condition of vessels  Patient  Expense  Urgency of situation

5. 5 IV Catheterization  Complications  Phlebitis  Local cellulitis  Septicemia  Collapsed veins or hematomas rendering veins unusable

6. 6 IV Catheterization Types  Winged needle (butterfly) catheter  Plastic wings on needle shaft facilitate placement and taping (if needed)  Tubing extending from needle to syringe connector port allows maneuverability  Is for short-term use  Used for:  blood collection  Administration of non-irritating medications  Moves out of vessel easily because of needle

8. IV Catheter Types  Over-the-needle catheter  Used primarily for peripheral vein catheterization  Come in many different sizes (gauges) that coordinate (color) with needle sizes  Needlepoint extends beyond catheter tip for entry into vein  Once catheter is placed, needle is withdrawn from insertion site MOST COMMON IV CATHETER USED

10. 10 IV Catheter Types  Through-the-needle  Usually longer than over-the-needle catheters (8- to 12-inch) and are primarily used for jugular vein  Once catheter is placed, needle is withdrawn from insertion site and a needle guard is placed over needle  Protects needle from sticking animal and shearing catheter http://www.youtube.com/watch?v=AxSCCwd N1nI

11. IV Catheter Types  Multi-lumen catheter  Have two to three separate lumens allowing simultaneous infusions at one catheter site  Placement is usually completed per- cutaneously with a guidewire  More expensive than other catheters Used primarily in Jugular catheterization

13. 13 Peripheral Catheterization Sites Dogs and cats  Cephalic, medial saphenous (cat) and lateral saphenous (dog)  20-gauge, 22-gauge, and 25-gauge, 1- to 1.5-inch catheters  20-gauge, 22-gauge, 23/25-gauge, ` 5/8” butterfly catheters

14. Peripheral Catheterization ALWAYS REMEMBER Start on the distal portion of the limb and move proximal for all catheter placement

15. 15 Peripheral Vein Butterfly Catheterization Supplies  Clippers  Antiseptic scrub and solutions  Catheter  A syringe filled with flush  heparinized saline  Saline  Tape and/or non-absorbable suture (not always used)

16. Butterfly Catheter Placement Procedure  Venipuncturist can hold the wing of the catheter up or down when placing catheter  Once in vessel, blood will flow back into the clear tubing  Syringe can be attached to tubing end and blood can be pulled into syringe for blood draw  Digital pressure required from restrainer  Syringe can be attached to tubing end and medications or flush can be administered through tubing  Release of digital pressure required from restrainer

17. Butterfly Catheter Placement http://www.youtube.com/watch?v=qsTAKiA3Uf0

18. 18 Peripheral Vein Catheterization Supplies  Clippers  Antiseptic scrub and solutions  Catheter  A syringe filled with flush  heparinized saline  Saline  Injection cap or T-connector  Tape and/or non-absorbable suture  Bandage material

19. 19 Peripheral Vein Catheterization Procedure  Shave area of insertion site  Surgical prep with antiseptic scrub and solution  Aseptic technique is important to prevent infection  A relief hole may be made with a #11 blade or 20- gauge needle to reduce friction  Indicated in severely dehydrated patients or patients with tough skin  Occlude vein proximal to insertion site with tourniquet or an assistant

21. 21 Peripheral Vein Catheterization Procedure cont..  Grasp distal portion of leg and extend it to help immobilize the vein  With bevel up, insert catheter through skin or relief hole at approximately 15- degree angle  Advance catheter into vessel; when blood flashes in (hub), needle and catheter are advanced together as a unit for an additional 1-4 mm

23. 23 Peripheral Vein Catheterization Procedure cont..  Hold needle still and advance the catheter ONLY into vessel  Cap catheter with an injection cap or T- connector and flush catheter  Secure catheter with tape wrapped around hub of catheter and then around leg

25. Taping in of Peripheral Catheters  Taping techniques vary from person to persona and hospital to hospital  There is not one “right way” to tape a catheter in  Always remember to:  Secure the catheter hub and injection port  Never secure tape to tightly  Be sure patients leg is dry prior to applying tape

28. Peripheral Catheter Placement http://www.youtube.com/watch?v=wt_K1beUZEI http://www.youtube.com/watch?v=pUdJqaEe4Fw

29. 29 Jugular IV Catheterization  Procedure  Site chosen is shaved and surgically prepped  Wipe or spray with betadine solution, left to dry on  2-5 ml of lidocaine given ID over and above insertion site  Create sterile field by opening sterile gloves, and laying opened catheter on gloves  Other items are either placed on sterile field or in cold sterilization tray  Sterile gloves are worn

30. 30 Jugular IV Catheterization  Hold catheter in dominant hand—other gloved hand occludes jugular  Insert catheter into skin at approximately 45- degree angle, toward heart  Flash of blood in hub indicates vessel is hit, advance centimeter more  Hold needle still, sliding catheter into vessel; remove needle  Check to make sure vein is still catheterized by applying digital pressure  Attach a PRN or T-port and suture catheter into place

34. http://www.youtube.com/watch?v=AxSCCwdN1nI

35. Multi-Lumen Catheter Placement http://www.youtube.com/watch?v=RGXP-FSjih8

36. 36 Jugular IV Catheterization  Apply small amount of antibacterial ointment before placing wrap over catheter  Wrap neck or apply stents over catheters to stabilize them and to prevent them from getting rubbed out

38.  Examples of four types of IV catheters. Catheter A is a butterfly; catheter B is an OTN; catheter C is a multilumen (Triple-lumen); and catheter D is a through-the- needle.

39. 39 IV Catheter Maintenance  If any of these things occur, remove catheter and place a new one in a different location:  Phlebitis  Infection  Thrombosis  Leaking at insertion site by itself or during a flush  Pain upon injection  Any portion of the catheter is exposed

40. 40 IV Catheter Maintenance  If catheter site looks good, then clean with iodophor or chlorhexidine solution  Recommended not to leave a catheter in place longer than 72 hours  If bandage gets wet, reason should be identified and bandage changed

41. 41 IV Catheter Maintenance  If patient is chewing at bandage, reason should be investigated  Catheters not continuously used should be flushed with 4 U/ml of heparinized saline (1000 units/ 250 ml normal saline) every 4 hours  Bags of heparinized saline are discarded every 12-24 hours to minimize risk of contamination